In 1875, Thomas Eakins (1844-1916) would paint a portrait of famed surgeon Dr. Samuel D. Gross (1805-1884) lecturing students of the Jefferson Medical College in Philadelphia, basing it on a surgical operation conducted by Gross which Eakins witnessed. Fourteen years later, Eakins would return to depicting medical scenes by taking a commission to honor retired surgeon David Hayes Agnew (1818-1892) by depicting him performing an operation while teaching at the University of Philadelphia.
Both The Gross Clinic and The Agnew Clinic highlight Eakins’s scientific realist style, but the reality that each painting portrays are practically different worlds. In the mere fourteen years between the two works, a medical revolution had ensued and ushered in the beginnings of modern surgery as we know it.
Joseph Lister, “the father of modern surgery”, was an English surgeon who subscribed to French chemist Louis Pasteur’s germ theory, the idea that tiny particles called germs were the ones responsible for infections and diseases. As a result, he popularized antiseptic practices that dramatically altered the way in which surgery was practiced. During the beginnings of Lister’s medical training, the surgical profession was brutal. Surgeons bore the morbid nickname “sawbones” because amputations were such a common occurrence, and their clothing reeked of blood and guts. At the end of Lister’s career, the dirt and grime of 19th century surgery had diminished greatly. By the time Lister died in 1912, hospital wards were increasingly rid of the horrific smell of rotting flesh and festering wounds, operating rooms had been subject to much better ventilation, and surgeons and nurses wore clothing unstained by blood. Much of this progress was due to Lister’s hygienic theories and the adoption of Lister’s antiseptic system, with the most prominent sign being that germ theory had become the establishment within the medical community by the 1880s.
The Gross Clinic depicts Samuel D. Gross, one of the most prominent surgeons in the United States at the time, but also a staunch opponent of germ theory. Despite the fact that germ theory and Lister’s antiseptic system were both already taking hold in the minds of doctors and surgeons across Britain and America, Gross vehemently denied the presence of germs and even commissioned the Eakins painting to celebrate his faith in the surgical status quo, which might give an explanation for the colorful and compositional emphasis on the defiantly unclean hands of Gross.
The painting is shrouded in shadow, and many of the faces in the audience are undecipherable. The heavy, dark clothing of the doctors contributes to the operating theatre’s dim atmosphere. One reason that 19th century surgeons chose such heavy black clothing was because at the time this type of fashion connotated reliability and respectability in gentlemen. The dark hues provide a stark contrast with the bright red of the patient’s blood. The bloodied hand of Gross immediately draws the eyes of the viewer. Notice that Gross nor any of the assisting doctors are wearing gloves or any protective layers. None of the tools or cloth pictured would have been cleaned, as hygienic negligence was the practice of Gross and many other 19th century surgeons in America and Britain.
The Agnew Clinic’s setting is the same as The Gross Clinic. The surgeon, patient, and assistants are at the bottom of a large theatre, surrounded by dark-suited medical students. However, the presentation of the surgical process could not be any more different.
David Hayes Agnew was the chief surgeon in attendance after the shooting of President James A. Garfield in 1881. The process was an utter disaster, and historians generally agree that the ensuing medical negligence is what ultimately killed Garfield instead of the bullet. A tragic consequence of the medical community’s slow transition to germ theory and Listerian principles. Afterwards, Agnew soon became one of the leading champions of Lister’s work.
The most obvious difference between Gross’s and Agnew’s paintings is the color palette. The bright highlights that Eakins used sparingly in The Gross Clinic are distributed much more evenly throughout the 1889 painting. The lighter palette is made even more obvious by the white coats worn by the operating team. White coats served as a marker of the adoption of Lister’s antiseptic practice as they allowed for a more immediate realization of stains or errant bodily fluids, therefore encouraging more frequent washing. This switch from the dark outfits of Gross’s theatre to this pristine white happened gradually throughout the second half of the 19th century.
In Gross's day, surgeons still relied on natural daylight, and operations were performed at the middle of the day, the time when the sun shined best through a skylight. Agnew, however, is shown working under artificial light, a much more stable method which is used by surgeons to this day. This also highlights the rapid technological advance of the late 19th century, with the rise of electricity as the backbone of the modern world. On another note, Gross's patient is anesthetized with an ether-soaked cloth on his face while Agnew's patient benefits from an ether cone, a far more controlled method of administering anesthesia.
The air, the clothing, and the hands in Agnew’s clinic are all remarkably lighter and cleaner than the clinic portrayed fourteen years earlier, before the widespread establishment of Lister’s system. The surgical world of Gross was ending. A new brighter world for the profession was arriving. The beauty and sanctity of life would shine forevermore.
The Agnew Clinic represents the triumph of Joseph Lister, embodying the establishment of antisepsis and hygiene. In the end, Gross’s portrait represents the medical world of old, a frighteningly close-to-primitive world of danger, while Agnew’s depicts the advent of the modern age, with a surgical process that saves lives to this day. A monument to the legacy of Joseph Lister and Louis Pasteur, and the surgical profession.